Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Sunday, January 09, 2005

The Silent Tsunami

After initially pledging $4 million for Asian disaster relief, the Bush Administration has finally pledged $350 million -- quite a lot of money, enough to run the war in Iraq for three or four days.

UN official Jan Engelund generated a storm of indignant huffing and puffing in the U.S. when he accused the wealthy nations of being stingy, but he wasn't even talking about the tsunami. He was talking about ongoing, everyday reality. According to The State of the World's Children, 2005, issued recently by the United Nations Children's Fund, about 29,000 children die under five every day from readily preventable causes -- diarrhea, malaria, measles -- which are almost unheard of as causes of child death in the wealthy countries. The report is a long PDF, which will take a few minutes to download at 56K, but you can read it here.

It would be feckless for me to try to summarize it in a way that would do it justice, but here is an excerpt from the summary:

• Poverty is the root cause of high rates of
child morbidity and mortality. The rights
of over 1 billion children – more than
half the children in developing countries –
are violated because they are severely
underserved of at least one of the basic
goods or services that would allow them
to survive, develop and thrive. In the
developing world more than one in three
children does not have adequate shelter,
one in five children does not have
access to safe water, and one in seven
has no access whatsoever to essential
health services. Over 16 per cent of children
under five lack adequate nutrition
and 13 per cent of all children have
never been to school.

• Armed conflict. As civil strife proliferates –
and civilians become its main causalities
– millions of children are growing up in
families and communities torn apart by
armed conflict. Many have been forced
onto the front lines. Since 1990, conflicts
have directly killed as many as 3.6 million
people; tragically, more than 45 per
cent of these are likely to have been children.
8 Hundreds of thousands of children
are caught up in armed conflict as
soldiers, are forced to become refugees
or are internally displaced, suffer sexual
violence, abuse and exploitation, or are
victims of explosive remnants of war.

• HIV/AIDS. AIDS is already the leading
cause of death worldwide for people
aged 15 to 49; in 2003 alone, 2.9 million
people died of AIDS and 4.8 million
people were newly infected with HIV.9
Over 90 per cent of people currently
living with HIV/AIDS are in developing
countries. In sub-Saharan Africa,
HIV/AIDS has led to rising child mortality
rates, sharp reductions in life expectancy
and millions of orphans.

As we discuss people in the U.S. who lack access to preventive care, the frustrations many of us experience in communicating with our physicians and interacting with the system, and the injustices and inequalities in our society that make our own health status and life expectancy worse than in other wealthy countries, we need to keep it in context. We are damned lucky, and we owe the world far more than we are giving.